Portal Hypertension | Diagnosis & Treatment

How is portal hypertension diagnosed?

Because portal hypertension can cause a variety of complications, clinicians often look for signs of gastrointestinal bleeding, an enlarged spleen, the development of varices and abdominal swelling (ascites) to determine if a child has the condition.

Using ultrasound, a painless and non-invasive imaging technology, clinicians can see the direction and speed of the blood flow through the portal vein. This technology also lets clinicians assess the state of the liver, spleen and gallbladder and see whether varices have developed. Often, ultrasound is the first way in which “cavernous transformation of the portal vein,” a network of smaller, more fragile varices that bypass the liver, is diagnosed. Clinicians can also use techniques, such as a special computed tomography or CT scan (called a “CTA” or “CT angiogram”) or magnetic resonance imaging (MRI) to see the portal vein and related blood vessels.

Clinicians may also use an endoscope – a thin, flexible, lighted tube – to look for varices in the esophagus. If the child is old enough and can swallow a capsule, a wireless capsule endoscopy may be done instead. In this case, a tiny camera in a capsule sends digital pictures to a computer as the capsule itself goes down the esophagus.

If they discover that varices are bleeding, physicians can use an endoscope to deliver some forms of treatment aimed at controlling this complication.

How is portal hypertension treated?

Physicians often prescribe treatment with a medication called a nonselective beta blocker, such as propranolol or nadolol, which can help lower blood pressure within the portal vein.

Control or prevention of bleeding from varices is a high priority with portal hypertension. To do this, physicians often use an endoscope to tie off varices using a rubber band (a procedure known as “banding”) or to deliver sclerosing therapy. In this kind of therapy, a physician injects a chemical into the varices directly, causing them to clot.

If a child develops significant ascites, physicians may try to relieve the fluid load with diuretic medications or, if necessary, by draining the fluid from the abdomen with a needle (a non-surgical procedure called abdominal paracentesis).

If a child continues to bleed internally, doctors may create a bypass or shunt between the portal vein and the rest of the bloodstream. Physicians often use one of two types of shunting procedures, transjugular intrahepatic portal-systemic shunting (TIPSS, a non-surgical procedure involving use of a catheter) or surgical shunting. Both procedures relieve the pressure on the portal vein and redistribute it to the rest of the bloodstream.

Because portal hypertension is an advanced complication of other forms liver disease, such as cirrhosis, it is important to try to manage the conditions that caused damage to the organ in the first place. Should liver function begin to fail, a liver transplant may become necessary.

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